Abstract
SUMMARYObjective: The objective of the current study is the identification of the main and supplementary motor and speech areas of the human brain with the use of fMRI, as well as the connections between them with bundles of white matter with the use of DTI in patients as part of the preoperative planning.Materials and methods: The study contained two groups. The first one was the control group, consisting of 6 healthy volunteers, 4 males and 2 females, with an average age of 40±4 years, and was used in order to choose the most efficient motor and lingual tests of fMRI for the main study. The main study group consisted of 36 patients, 20 males and 16 females, aged 40±12,3 with brain pathology in the setting of the preoperative planning. The patient selection was performed in the General National Hospital of Athens «G. Gennimatas», whereas the fMRI examination took place in a specialized radiology center. All the patients were subjected to classic MRI studies (Τ1,Τ2, Τ2 *,T2 flair, BRAV ...
SUMMARYObjective: The objective of the current study is the identification of the main and supplementary motor and speech areas of the human brain with the use of fMRI, as well as the connections between them with bundles of white matter with the use of DTI in patients as part of the preoperative planning.Materials and methods: The study contained two groups. The first one was the control group, consisting of 6 healthy volunteers, 4 males and 2 females, with an average age of 40±4 years, and was used in order to choose the most efficient motor and lingual tests of fMRI for the main study. The main study group consisted of 36 patients, 20 males and 16 females, aged 40±12,3 with brain pathology in the setting of the preoperative planning. The patient selection was performed in the General National Hospital of Athens «G. Gennimatas», whereas the fMRI examination took place in a specialized radiology center. All the patients were subjected to classic MRI studies (Τ1,Τ2, Τ2 *,T2 flair, BRAVO).Also DWI, DTI 25 directions 1000b and brain mapping with the method of fractional anisotropy were performed, and were used for the tractography. The scanner was 1,5 Tesla GENERAL ELETRIC, and the fMRI DICOM were proccesed in a work station. The tractography was performed with the Brainance programm (Advantis medical imaging, Eindhoven). With the use of the gathered data the main white matter tracts (arcuate fasciculus, optic radiation, corpus callosum, inferior frontoccipital fasciculus, inferior and superior longitudinal fasciculus, corticospinal tract, U fibers and cingulate fasciculus) were visualized. The main and supplementary areas of every fMRI test were recorded, and were checked for connections. These were categorized with qualitative (presence or not of connections) and quantitative (no connection-sparse-many-a lot) criteria. The statistical analysis was done with the use of the SPSS statistical package. Results: A statistical significant connection was seen in many tests between the demographic data (eg age, diagnosis, pathological area) and the presence of main and supplementary areas. This was mainly seen in speech, and especially in the opposite words and word generation tests. An increased percentage of connections were seen in the speech tests. These consist of functional as well as anatomical connections and are mainly represented by the superior longitudinal fasciculus and its four subgroups, either partially or throughout its course. In the parroting test the patients with both main activation areas in fMRI had more connections between the main areas than patients with only one (p<0.001). Also these connections were considerably more numerous (p=0.011). In the left hand finger tapping test the size of the pathology had a statistical significant relation with the connections between the the main areas (p=0.021). The bigger the area the more the connections depicted. A statistically significant result was also seen between the gender and the supplementary areas connections in the word generation and left foot motion tests. More specifically men showed less connections than women. On the other hand at the left hand finger tapping tests men had statistically more connections between main and supplementary areas (p=0.046).Concusions: The study of complicated neuronal networks like the brain, is feasible with the use of fMRI, DTI and fMRI-DTI fusion. In the current study important structural and functional connections between the main activation areas were seen, as well as between the main and supplementary areas in both spech and motion. Despite this, the visualization of the connections depends on the efficiency of the software, whereas in the preoperative planning it has a prognostic value whithout however significanrtly affecting the course of surgery.
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